Vertigo medical therapy: Difference between revisions

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Revision as of 18:22, 5 January 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S [2]

Overview

Single drug therapy is usually not effective to minimize the symptom, a combination of antihistamine and antiemetic are used to control vertigo. Definitive therapy is treating the underlying cause of vertigo.

Medical Therapy

Acute/severe attacks of vertigo usually subsides in a day or two after brainstem compensation.^[1]
Supportive therapy includes bed rest, antihistamine, antiemetic, benzodiazepines (diazepam,lorazepam) to relief the symptom.
Meclizine is the common antihistamine used and is safe in pregnancy. Other antihistamines used are betahistine and dimenhydrinate.^[2]
Scopolamine (hyoscine hydrobromide) is a common anticholinergic used to treat the symptom.^[3]
Due to the sedative effect of these drugs they should be used carefully in the elderly.
These drugs should not be used for a long period of time as it may delay the compensatory mechanism in the brainstem and result in the prolongation of vertigo symptom.
Some patients may be a candidate for vestibular rehabilitation, it improves balance and decreases dizziness by exercises that stabilize gait and gaze.

Treatment for Common Causes of Vertigo


Treating Peripheral Vertigo
Ménière’s disease	Treatment is focused on preventing acute attacks and controlling the excess fluid build-up. Non-invasive: Low-sodium diet, hearing aid, positive pressure therapy. Medications: Meclizine, diazepam, promethazine, diuretics Steroid^[4] or gentamicin^[5] injections in middle ear. Surgery: Decompress endolymphatic sac, labyrinthectomy, Vestibular nerve section^[6].
Acoustic neuroma	Observe if the tumor is small, asymptomatic, not growing, or in elderly with comorbidities. For large, symptomatic, growing tumor one of the following treatment is helpful after weighing risks and benefits: Radiotherapy Radiosurgery Surgical removal
Benign paroxysmal positional vertigo	Effective maneuvers:Epley maneuver, Semont maneuver, Brandt–Daroff exercises, Roll maneuver.^[7] Medical: Antihistamine(meclizine) and anticholinergic(scopolamine).^[8] Surgical: For resistant and severe cases occlusion of semi-circular canal may be helpful.
Acute labyrinthitis	Depends upon the etiology: Viral: hydration, bedrest.^[9] Bacterial: Antibiotic depending on the origin of infection that led to labyrinthitis.
Acute vestibular neuritis	Symptomatic:Antiemetic, antihistamine, benzodiazepines. These medicines should not be used for more than three days as the central compensation can get delayed leading to recurrent, chronic vertigo.^[10] Steroid efficacy is controversial. ^[11]
Cholesteatoma	Surgical removal followed by periodic follow-ups.
Otosclerosis	Medical: Sodium flouride can slow the progression. ^[12] Surgical procedure of choice is stapedectomy.^[13]
Treating Central Vertigo
Brainstem Stroke	Folow stroke management protocol.
Vestibular Migraine	Antiemetic coupled with medicines that relieve symptomatic vertigo.^[14]
Multiple Sclerosis	Disease-modifying drugs such as glatiramer acetate, interferon-beta, natalizumab, mitoxantrone are effective in treat relapsing-remitting type. For the secondary progressive, progressive-relapsing, and primary progressive type disease-modifying drugs are less effective. Acute relapses are managed by treating the triggering cause, symptomatic therapy, corticosteroids, and/or rehabilitation.
Cerebellopontine angle tumors	Observation, radiotherapy, or microsurgery is selected as a plan of treatment after assessing the size/growth of the tumor, age of the patient, and comorbidities.^[15]

Reference

↑ Kuo CH, Pang L, Chang R (2008). "Vertigo - part 2 - management in general practice". Aust Fam Physician. 37 (6): 409–13. PMID 18523693.
↑ Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.
↑ Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.
↑ Phillips, John S; Westerberg, Brian (2011). "Intratympanic steroids for Ménière's disease or syndrome". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008514.pub2. ISSN 1465-1858.
↑ Postema, Rolf J.; Kingma, Charlotte M.; Wit, Hero P.; Albers, Frans W.J.; Van Der Laan, Bernard F.A.M. (2009). "Intratympanic gentamicin therapy for control of vertigo in unilateral Menière's disease: a prospective, double-blind, randomized, placebo-controlled trial". Acta Oto-Laryngologica. 128 (8): 876–880. doi:10.1080/00016480701762458. ISSN 0001-6489.
↑ Syed, I.; Aldren, C. (2012). "Meniere's disease: an evidence based approach to assessment and management". International Journal of Clinical Practice. 66 (2): 166–170. doi:10.1111/j.1742-1241.2011.02842.x. ISSN 1368-5031.
↑ {{cite journal|journal=Cochrane Database of Systematic Reviews|issn=14651858
↑ "Meclizine Hydrochloride Monograph for Professionals". American Society of Health-System Pharmacists. Retrieved 22 March 2019
↑ Seemungal, B M; Bronstein, A M (2008). "A practical approach to acute vertigo". Practical Neurology. 8 (4): 211–221. doi:10.1136/jnnp.2008.154799. ISSN 1474-7758.
↑ Muncie HL, Sirmans SM, James E (2017). "Dizziness: Approach to Evaluation and Management". Am Fam Physician. 95 (3): 154–162. PMID 28145669.
↑ Fishman, Jonathan M; Burgess, Chris; Waddell, Angus (2011). "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008607.pub2. ISSN 1465-1858.
↑ de Oliveira Penido, Norma; de Oliveira Vicente, Andy (2018). "Medical Management of Otosclerosis". Otolaryngologic Clinics of North America. 51 (2): 441–452. doi:10.1016/j.otc.2017.11.006. ISSN 0030-6665.
↑ Mahafza T, Al-Layla A, Tawalbeh M, Abu-Yagoub Y, Atwan Sulaiman A (2013). "Surgical Treatment of Otosclerosis: Eight years' Experience at the Jordan University Hospital". Iran J Otorhinolaryngol. 25 (73): 233–8. PMC 3846245. PMID 24303446.
↑ Sargent, Eric W. (2013). "The challenge of vestibular migraine". Current Opinion in Otolaryngology & Head and Neck Surgery. 21 (5): 473–479. doi:10.1097/MOO.0b013e3283648682. ISSN 1068-9508.
↑ Huang, May Y; Vermeulen, Sandra (2003). "Clinical perspectives regarding patients with internal auditory canal or cerebellopontine angle lesions: Surgical and radiation oncology perspectives". Seminars in Ultrasound, CT and MRI. 24 (3): 124–132. doi:10.1016/S0887-2171(03)90034-5. ISSN 0887-2171.

[pmid18523693-1] Kuo CH, Pang L, Chang R (2008). "Vertigo - part 2 - management in general practice". Aust Fam Physician. 37 (6): 409–13. PMID 18523693.

[2] Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.

[3] Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.

[PhillipsWesterberg2011-4] Phillips, John S; Westerberg, Brian (2011). "Intratympanic steroids for Ménière's disease or syndrome". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008514.pub2. ISSN 1465-1858.

[PostemaKingma2009-5] Postema, Rolf J.; Kingma, Charlotte M.; Wit, Hero P.; Albers, Frans W.J.; Van Der Laan, Bernard F.A.M. (2009). "Intratympanic gentamicin therapy for control of vertigo in unilateral Menière's disease: a prospective, double-blind, randomized, placebo-controlled trial". Acta Oto-Laryngologica. 128 (8): 876–880. doi:10.1080/00016480701762458. ISSN 0001-6489.

[SyedAldren2012-6] Syed, I.; Aldren, C. (2012). "Meniere's disease: an evidence based approach to assessment and management". International Journal of Clinical Practice. 66 (2): 166–170. doi:10.1111/j.1742-1241.2011.02842.x. ISSN 1368-5031.

[7] {{cite journal|journal=Cochrane Database of Systematic Reviews|issn=14651858

[8] "Meclizine Hydrochloride Monograph for Professionals". American Society of Health-System Pharmacists. Retrieved 22 March 2019

[SeemungalBronstein2008-9] Seemungal, B M; Bronstein, A M (2008). "A practical approach to acute vertigo". Practical Neurology. 8 (4): 211–221. doi:10.1136/jnnp.2008.154799. ISSN 1474-7758.

[pmid28145669-10] Muncie HL, Sirmans SM, James E (2017). "Dizziness: Approach to Evaluation and Management". Am Fam Physician. 95 (3): 154–162. PMID 28145669.

[FishmanBurgess2011-11] Fishman, Jonathan M; Burgess, Chris; Waddell, Angus (2011). "Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008607.pub2. ISSN 1465-1858.

[de_Oliveira_Penidode_Oliveira_Vicente2018-12] Oliveira Penido, Norma; de Oliveira Vicente, Andy (2018). "Medical Management of Otosclerosis". Otolaryngologic Clinics of North America. 51 (2): 441–452. doi:10.1016/j.otc.2017.11.006. ISSN 0030-6665.

[pmid24303446-13] Mahafza T, Al-Layla A, Tawalbeh M, Abu-Yagoub Y, Atwan Sulaiman A (2013). "Surgical Treatment of Otosclerosis: Eight years' Experience at the Jordan University Hospital". Iran J Otorhinolaryngol. 25 (73): 233–8. PMC 3846245. PMID 24303446.

[Sargent2013-14] Sargent, Eric W. (2013). "The challenge of vestibular migraine". Current Opinion in Otolaryngology & Head and Neck Surgery. 21 (5): 473–479. doi:10.1097/MOO.0b013e3283648682. ISSN 1068-9508.

[HuangVermeulen2003-15] Huang, May Y; Vermeulen, Sandra (2003). "Clinical perspectives regarding patients with internal auditory canal or cerebellopontine angle lesions: Surgical and radiation oncology perspectives". Seminars in Ultrasound, CT and MRI. 24 (3): 124–132. doi:10.1016/S0887-2171(03)90034-5. ISSN 0887-2171.

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@@ Line 8: / Line 8: @@
 ==Medical Therapy==
 *[[Acute]]/severe attacks of vertigo usually subsides in a day or two after brainstem compensation.<ref name="pmid18523693">{{cite journal| author=Kuo CH, Pang L, Chang R| title=Vertigo - part 2 - management in general practice. | journal=Aust Fam Physician | year= 2008 | volume= 37 | issue= 6 | pages= 409-13 | pmid=18523693 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18523693  }} </ref>
-*Supportive therapy includes bed rest, [[antihistamine]], [[antiemetic]] to relief the [[symptom]].
+*Supportive therapy includes bed rest, [[antihistamine]], [[antiemetic]], [[benzodiazepines]] ([[diazepam]],[[lorazepam]]) to relief the [[symptom]].
 *[[Meclizine]] is the common [[antihistamine]] used and is safe in [[pregnancy]]. Other [[antihistamines]] used are [[betahistine]] and [[dimenhydrinate]].<ref> Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.</ref>
-*[[Scopolamin]] ([[hyoscine hydrobromide]]) is a common [[anticholinergic]] used to treat the symptom.<ref> Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.</ref>
+*[[Scopolamine]] ([[hyoscine hydrobromide]]) is a common [[anticholinergic]] used to treat the symptom.<ref> Khilnani, AK; Thaddanee, R; Khilnani, G (July 2013). "Anti vertigo drugs-Revisited". National Journal of Integrated Research in Medicine. 4 (4): 118–28.</ref>
 *Due to the [[sedative]] effect of these drugs they should be used carefully in the elderly.
 *These drugs should not be used for a long period of time as it may delay the compensatory mechanism in the [[brainstem]] and result in the prolongation of vertigo [[symptom]].